The oxygen transport function of the blood and of the erythrocyte concentrate during storage and its importance for blood transfusion

The property of oxygen transport function was investigated in blood which had been stored in solutions of "glugizir" and "zitroglucophosphate" and in erythrocyte concentrates gained from it on the noughth, 7th, 14th und 21st day of storage at -4 +/- 2 degrees C. The parameters of the oxygen binding function (oxygen content of erythrocytes, half time of haemoglobin saturation with oxygen, concentration of organic phosphate [2.3 diphosphoglycerate and adenosine triphosphate] and those of inorganic phosphorus were determined in erythrocytes. During storage for more than 21 days no significant differences could be detected in the property of oxygen transfer between erythrocytes of stored blood and erythrocyte concentrate, with the values for storing in zitroglucophosphate being somewhat higher. Problems of applying all components of donor blood efficiently are discussed. In performing an adequate haemotherapy with blood components the importance of a functional condition of erythrocytes and oxygen balance in the organism of the receiver should be considered. The necessity of transfusing erythrocyte concentrate in the therapy of anaemias of different genesis is emphasized and the differences in applying concentrates in different plasma solutions are referred to. By transfusing concentrates the effectiveness of hemotherapy are elevated and the rate of complications and side-effects of whole blood are diminished.     

In vitro kinetics of oxygen transport in erythrocyte suspension or unmodified hemoglobin solution from human and other animals

Oxygen transport behavior in erythrocyte suspension or in hemoglobin solution was studied as a potential therapeutic model for the clinical treatment of blood loss, and this can also provide physiological data with which to evaluate blood substitutes. In the present project, we examined the in vitro kinetics of hemoglobin binding to and releasing oxygen, to provide detailed oxygen-flux measurements for unmodified hemoglobin solutions and erythrocyte suspensions in human, as well as other vertebrates. An in vitro method was used, based on a widely used artificial system, with the oxygen saturation level being detected in real time. Results from this study indicated that the kinetic curves of human erythrocyte suspensions and hemoglobin solutions were either S-shaped or hyperbolic, respectively. Based on these curves, the significance of T(50) emerged in our investigation, where T(50) is defined as the time needed for 50% hemoglobin to be saturated with oxygen, and reflects the efficiency with which hemoglobin carries oxygen. This parameter may be used to diagnose blood diseases, and could be a standard for evaluating blood substitutes. In this study, we also compared the T(50) of 4 species of vertebrates, and found that it shows a distinct efficiency of oxygen binding related to species, and potentially reveals the evolutionary function of hemoglobin and its possible adaptation to the environment.     

Functional characteristics of normal and pathologic erythrocytes

Polarographic titration in a closed cell of blood samples and concentrated Hb solutions was used to study the regulation of the release of oxygen by the red cell. The effect of temperature, polyethylenglycol and metabolites normally found in the erythrocyte was determined by spectrophotometric and polarographic methods. Some pecularities of O2-transport and release in beta-thalassemia, functional hypoxia and Cooley-disease are described.     

Hypoxanthine and xanthine levels determined by high-performance liquid chromatography in plasma, erythrocyte, and urine samples from healthy subjects: the problem of hypoxanthine level evolution as a function of time

The levels of hypoxanthine and xanthine are determined in plasma, erythrocyte, and urine samples by a reverse-phase high-performance liquid chromatographic (HPLC) method. The hypoxanthine concentration increases in erythrocyte and plasma samples when whole blood is stored at room temperature between sampling and centrifugation. Furthermore, the hypoxanthine concentration increases in erythrocyte samples when they are kept apart at room temperature before analysis, whereas the plasma hypoxanthine level remains constant. This result proves an endogenous formation of hypoxanthine in erythrocytes with time, at room temperature. These studies show the necessity of rigorous conditions for the collection, transport, and treatment of blood samples. In order to achieve accurate results, the blood must be centrifuged immediately after collection. The erythrocyte and plasma samples must be stored frozen until deproteinization and HPLC analysis. Under these conditions, the concentrations of hypoxanthine and xanthine in plasma are 2.5 +/- 1 and 1.4 +/- 0.7 microM, respectively. In erythrocyte samples, hypoxanthine concentration reaches 8.0 +/- 6.2 microM.     

A novel device for the non-invasive measurement of free hemoglobin in blood bags.

The production of red blood cell concentrates from human donors is a very expensive procedure and human resources are in short supply. Under perfect storage conditions at a temperature of 2-6 degrees C, a blood bag must be used within 35-49 days (in Germany). Visual inspection of the bag for apparent hemolysis by a blood bank physician is a crucial but subjective quality control assessment. Since an interruption of the cold chain cannot be definitely ruled out, bags are often disposed of prematurely for safety reasons. There is currently no method of testing a closed blood bag with respect to hemolysis for its suitability to be used in a transfusion. The proposed optical measuring device is a hemoglobin sensor which determines the free hemoglobin in standard erythrocyte concentrates without opening the bag. The optical measurements are done on the flexible tube connected to the main bag. The optical measurements were evaluated using standard hemoglobin solutions with an accuracy of 0.005 g/dL. These investigations show that in the future each blood bag can be tested non-invasively for its content of free hemoglobin. This will contribute to decreasing the wastage rate of red blood cell concentrates.     

Nonequilibrium-Facilitated Oxygen Transport in Hemoglobin Solution

We have used the quasi-linearization method to obtain numerical solutions to the equations which describe steady-state diffusion of oxygen through layers of hemoglobin solution. The numerical solutions show how the facilitated flux of oxygen depends upon the layer thickness, reaction-rate coefficients, and other parameters of the system. The results indicate that steady-state oxygen diffusion in layers of hemoglobin solution, similar to those studied by Scholander, should be adequately described by the models which assume chemical equilibrium exists throughout the layer, but for layers of concentrated hemoglobin solution about the thickness of a human erythrocyte, the facilitation of oxygen diffusion should be much less than the equilibrium models predict.     

Red blood cell aggredation: mechanisms, adrenergic regulation

Red blood cell aggregation is a complex multiple-factor process and exerts a substantial effect on realization of basic blood function: oxygen transport. Insufficient knowledge about mechanisms of erythrocyte aggregation in normal conditions and, especially, in pathological conditions, complicates the control and correction of possible negative consequences of this process. On addition, red blood cell aggregation process is a suitable model for the elucidation of basic patterns of intercellular interactions. The paper presents contemporary data on mechanisms of erythrocyte aggregation and contribution of plasma and membrane erythrocyte properties to this process. Currently available data on intracellular signal pathways are discussed.     

S-Nitrosohemoglobin is unstable in the reductive erythrocyte environment and lacks O2/NO-linked allosteric function

Our previous results run counter to the hypothesis that S-nitrosohemoglobin (SNO-Hb) serves as an in vivo reservoir for NO from which NO release is allosterically linked to oxygen release. We show here that SNO-Hb undergoes reductive decomposition in erythrocytes, whereas it is stable in purified solutions and in erythrocyte lysates treated with an oxidant such as ferricyanide. Using an extensively validated methodology that eliminates background nitrite and stabilizes erythrocyte S-nitrosothiols, we find the levels of SNO-Hb in the basal human circulation, including red cell membrane fractions, were 46 +/- 17 nm in human arterial erythrocytes and 69 +/- 11 nm in venous erythrocytes, incompatible with the postulated reservoir function of SNO-Hb. Moreover, we performed experiments on human red blood cells in which we elevated the levels of SNO-Hb to 10,000 times the normal in vivo levels. The elevated levels of intra-erythrocytic SNO-Hb fell rapidly, independent of oxygen tension and hemoglobin saturation. Most of the NO released during this process was oxidized to nitrate. A fraction (25%) was exported as S-nitrosothiol, but this fraction was not increased at low oxygen tensions that favor the deoxy (T-state) conformation of Hb. Results of these studies show that, within the redox-active erythrocyte environment, the beta-globin cysteine 93 is maintained in a reduced state, necessary for normal oxygen affinity, and incapable of oxygen-linked NO storage and delivery.     

The effects of chronic long-term intermittent hypobaric hypoxia on blood rheology parameters

The effect of chronic long-term intermittent hypobaric hypoxia (CLTIHH) on blood rheology is not completely investigated. We designed this study to determine the effect of CLTIHH on blood rheology parameters. Present study was performed in 16 male Spraque-Dawley rats that divided into CLTIHH and Control groups. To obtain CLTIHH, rats were placed in a hypobaric chamber (430 mmHg; 5 hours/day, 5 days/week, 5 weeks). The control rats stayed in the same environment as the CLTIHH rats but they breathed room air. In the blood samples aspirated from the heart, hematocrit, whole blood viscosity, plasma viscosity, plasma fibrinogen concentration, erythrocyte rigidity index and oxygen delivery index were determined. The whole blood viscosity, plasma viscosity, hematocrit and fibrinogen concentration values in the CLTIHH group were found to be higher than those of the control group. However, no significant difference was found in erythrocyte rigidity index and oxygen delivery index between the groups. Our results suggested that CLTIHH elevated whole blood viscosity by increasing plasma viscosity, fibrinogen concentration and hematocrit value without effecting the erythrocyte deformability. Hence, CLTIHH that may occur in intermittent high altitude exposure and some severe obstructive sleep apnea (OSA) patients may be responsible for hemorheologic changes in those subjects.     

Evaluation of internationally used blood stabilizers for effective erythrocyte substitution]

Haemotherapy developed in the direction of transfusing pure blood cell preparations, if possible and enlarging the therapy with plasma fraction considerably. Quality losses of haemotherapeutics will already occur when they are prepared. This is mainly due to the conditions of blood collecting, blood stabiliser, duration and storage temperature from the blood collecting to further processing as well as biological variability of the composition of the donor's blood. The amount of substrate available to erythrocytes differs in various blood stabilisers. Deplasmatized erythrocyte concentrates can be used after several weeks of storage, if a high glucose concentration is present in the blood stabiliser. In CPD media the function of erythrocytes, the oxygen supply of the tissue, will remain intact a week longer than in ACD media. This effect will be increased by xylitol and pyruvate as well as by adding bicarbonate simultaneously. In future a primary importance will have to be attached to an improved storage of erythrocytes in the form of resuspended buffy coat-free erythrocyte concentrates.     

Erythrocyte function of rats under emotional stress

The effect of neurogenic stress of the conflict-of-afferent-excitations-type on the oxidizing erythrocyte properties and qualitative and quantitative red blood changes has been studied. Neurogenic stress was demonstrated to significantly affect the erythrocyte functional state in rats. Activation of free-radical oxidation of erythrocyte membrane lipids took place, provoking changes in their permiability and disorders of oxygen fixation and release. It is suggested that these changes may be the underlying mechanism of the developing tissue hypoxia and play a leading role in the pathogenesis of cardiovascular diseases.     

The Metabolism of the Volatile Amines: V. The Spontaneous Formation of Ammonia in Shed Blood on Standing

The spontaneous formation of ammonia which takes place when shed whole blood is allowed to stand was investigated and was found to consist of a complex series of reactions. The rate of ammonia formation was initially rapid but gradually slowed, and the maximum amount of ammonia was formed after a period of about seven days. Both the type of anticoagulant used and the availability of oxygen influenced the rate of ammonia formation. This reaction was inhibited when the blood was kept frozen but it was found that the measurement of the ammonia content of frozen and thawed blood was both difficult and inaccurate. Dilute solutions of zinc bromide partially inhibited this reaction.Compounds which give rise to ammonia were found to be present in both plasma and erythrocytes, although the deamidation reactions took place solely within the erythrocytes. The total amount of ammonia formed depended on the hemoglobin content of the blood and varied in certain patients suffering from erythrocyte disorders.     

Seasonal changes of heart weight and erythrocytes in the Djungarian hamster, Phodopus sungorus

Djungarian dwarf hamsters (Phodopus sungorus) show an annual cycle in weight-specific metabolic rate with a high level during winter. These seasonal changes in oxygen demand are met by hematological adjustments, primarily based on an increased number of erythrocytes, but a decreased erythrocyte volume during winter. Subsequently, the diffusion area for blood gas exchange is increased during this time of high metabolic capabilities. Blood oxygen capacity (hemoglobin, 2,3-diphosphoglycerate (2,3-DPG) does not change with the season. However, seasonal changes in heart weight suggest changes in cardiac output, causing an increased blood flow per unit tissue weight during winter. This increase in circulatory efficiency, as well as changes in erythrocyte surface, are primarily controlled by photoperiod, since it occurred in hamsters living indoors at thermoneutrality but subjected to seasonal changes in photoperiod to the same extent as in hamsters living outdoors.     

Osmotic fragility of the erythrocyte membrane: characterization by modeling of the transmittance curve as a function of the NaCl concentration

The theoretical extinction of blood suspensions submitted to a slow dialysis is analyzed in terms of their NaCl concentration. The model involves two adjustable parameters, chi and K, related to swelling and hemolysis. During swelling, the erythrocyte volume is supposed to vary linearly with the saline concentration. During hemolysis, an exponential decay of the hemoglobin concentration in the erythrocyte is used. The theoretical transmittance curves are consistent with the measurements carried out at a wavelength of 0.808 microm on native and incubated blood samples. Chi and K are relevant parameters to characterize quantitatively the fragility of the erythrocyte membrane. The effect of a non ideal character of the hemoglobin solutions and of normal distributions of chi and K is also discussed.     

Calibration of oxygen meters and determination of the curve for hemoglobin dissociation by kinetics of oxygenation and deoxygenation of the blood

A method to determine optical oxygenometers calibration and hemoglobin--oxygen equilibrium curve for the undamaged blood is described. This method does not require the oxygen equilibrium between the blood plasma and erythrocyte cytoplasm and uses only readings of the oxygenometer calibrated.     

Bivariate and Multivariate Analyses of the Influence of Blood Variables of Patients Submitted to Roux-en-Y Gastric Bypass on the Stability of Erythrocyte Membrane against the Chaotropic Action of Ethanol

The stability of the erythrocyte membrane, which is essential for the maintenance of cell functions, occurs in a critical region of fluidity, which depends largely on its composition and the composition and characteristics of the medium. As the composition of the erythrocyte membrane is influenced by several blood variables, the stability of the erythrocyte membrane must have relations with them. The present study aimed to evaluate, by bivariate and multivariate statistical analyses, the correlations and causal relationships between hematologic and biochemical variables and the stability of the erythrocyte membrane against the chaotropic action of ethanol. The validity of this type of analysis depends on the homogeneity of the population and on the variability of the studied parameters, conditions that can be filled by patients who undergo bariatric surgery by the technique of Roux-en-Y gastric bypass since they will suffer feeding restrictions that have great impact on their blood composition. Pathway analysis revealed that an increase in hemoglobin leads to decreased stability of the cell, probably through a process mediated by an increase in mean corpuscular volume. Furthermore, an increase in the mean corpuscular hemoglobin (MCH) leads to an increase in erythrocyte membrane stability, probably because higher values of MCH are associated with smaller quantities of red blood cells and a larger contact area between the cell membrane and ethanol present in the medium.     

A micro-method for quantitative determination of acylneuraminic acids from erythrocyte membranes.

A micro-method is presented which enables the fast and exact determination of acid-hydrolyzed acylneuraminic acids in erythrocyte membranes. Erythrocytes from 1 ml of human and rabbit blood containing ACD buffer are, washed and hemolyzed on Millipore filters of pore size 1.2 mu. Acylneuraminic acids are released from the erythrocyte membranes still on the filters under the optimal conditions of 0.1 N HCl at 80 degrees C for 50 min. A prerequisite for the determination of the true amount of acylneuraminic acids using the periodic acid/thiobarbituric acid assay is the small-scale extraction of lipids from the hydrolysate and anion-exchange chromatography of acylneuraminic acids. The values thus obtained must be corrected, as 20% of acylneuraminic acids are destroyed during acid hydrolysis. In samples of human blood from 10 healthy individuals, on an average 223 nmol acylneuraminic acids per ml of packed erythrocytes were found, and in the same amount of rabbit erythrocytes, 1e method for a screening of the acylneuraminic acid content of erythrocyte membranes in hemolytic diseases or of other cell membranes is discussed.     

A quantitative framework for the design of acellular hemoglobins as blood substitutes: implications of dynamic flow conditions

The delivery of oxygen to tissue by cell-free carriers eliminates intraluminal barriers associated with red blood cells. This is important in arterioles, since arteriolar tone controls capillary perfusion. We describe a mathematical model for O(2) transport by hemoglobin solutions and red blood cells flowing through arteriolar-sized tubes to optimize values of p50, Hill number, hemoglobin molecular diffusivity and concentration. Oxygen release is evaluated by including an extra-luminal resistance term to reflect tissue oxygen consumption. For low consumption (i.e., high resistance to O(2) release) a hemoglobin solution with p50=15 mmHg, n=1, D(HBO2)=3 x 10(-7) cm(2)/s delivers O(2) at a rate similar to that of red blood cells. For high consumption, the p50 must be decreased to 5 mmHg. The model predicts that regardless of size, hemoglobin solutions with higher p50 will present excess O(2) to arteriolar walls. Oversupply of O(2) to arteriolar walls may cause constriction and paradoxically reduced capillary perfusion.     

Studying the influence of some reactive oxygen species on physical and chemical parameters of blood

The aim of this work was to estimate the dynamics of blood physical and chemical parameters when blood specimens were processed by singlet oxygen in vitro. Our experiments were executed with whole blood specimens of healthy people (n = 10). Each specimen was divided into five separate portions of 5 mL. The first portion was a control (without any exposures). The second one was processed by an oxygen-ozone mixture (at ozone concentration of 500 μg/L, the third portion by oxygen, and the fourth and fifth ones were processed by a gas mixture with singlet oxygen (50 and 100% of generator power). In blood samples after processing we studied the activity of lactate dehydrogenase, aldehyde dehydrogenase and superoxide dismutase, erythrocyte and plasma levels of glucose and lactate, acid-base balance and the partial pressure of gases in blood. It was found out, that blood processing by singlet oxygen leads to optimization of energy, detoxication and antioxidant enzymes functioning with changes in plasma and erythrocyte level of glucose and lactate, normalization of blood gases level and acid-base balance. Our results show, that the effect of singlet oxygen on enzyme activity is more pronounced than exposure to an oxygen-ozone gas mixture.     

Octamers and nanoparticles as hemoglobin based blood substitutes

Progress in developing a blood substitute is aided by new biotechnologies and a better understanding of the circulatory system. For Hb based solutions, there is still a debate over the best set of fundamental parameters concerning the oxygen affinity which is correlated with the oxidation rate, the cooperativity, the transporter size, and of course the final source of material. Genetic engineering methods have helped discover novel globins, but not yet the quantity necessary for the high demand of blood transfusions. The expanding database of globin properties has indicated that certain individual parameters are coupled, such as the oxygen affinity and the oxidation rate, indicating that one must accept a compromise of the best parameters. After a general introduction of these basic criteria, we will focus on two strategies concerning the size of the oxygen transporter: Hb octamers, and Hb integrated within a nanoparticle.